Traditional Birth Attendants Save Newborns Using Bulb Syringes

The bulb syringe is a part of many U.S. parents' armamentorium of infant supplies, but in other hands it can be truly a life saver.

In order to improve birth outcomes, many organizations have designed clean birth kits containing supplies and instructions to help birth attendants prevent infection. However, many “next-generation kits” are in the works to help manage other post-delivery complications impacting mothers and newborns. One such enhanced birth kit was tested in Zambia by Dr. Christopher Gill—the first we’ve seen that has incorporated the bulb syringe for use by traditional birth attendants (TBAs).

Given the critical healthcare role played by TBAs in Zambia’s rural areas, the Lufwanyama Neonatal Survival Project (LUNESP) set out to determine whether training TBAs to manage common perinatal conditions could reduce neonatal mortality. The intervention group was trained to prevent hypothermia by drying and swaddling newborns; to prevent asphyxia by clearing the airway with a bulb syringe; and to treat sepsis using antibiotics and a health facility referral. The control group continued their existing standard of care, including the use of clean birth kits.

The results of the study were stupendous—neonatal mortality was 45% lower among TBAs that had been trained to recognize and treat perinatal conditions. This translated to one death avoided for every 56 births attended by a TBA with LUNESP training—showing great promise for enhanced birth kits and the enhanced role of TBAs.

Below, Dr. Gill responds to a few questions posed by Maternova.

Are the bulb syringes readily available in Zambia or did you need to import them?

We purchased these in bulk state side and shipped them to Zambia. They take up quite a lot of space unfortunately, so local procurement would be preferable if they can be sourced cheaply. I believe that ours went for something around 10 cents each, but the shipping costs added to that. Please note that we have just had our companion cost effectiveness article accepted to PLOS ONE, and in this we give an accounting of the costs for each of these items.

Do you have estimates of the cost of the full kit the TBAs were given/used?

This is a bit trickier to answer because some of the kits were donated by UNICEF. However, after asking the program manager (Anna Knapp), she recalls that at the time they were about $4 USD each. At least for the non-donated kits, we assembled them ourselves by buying the components in bulk and packing them into large Ziploc bags.

Has the MOH scaled up any of these interventions?

The MOH has not. Still, Zambia's official position is that all deliveries must occur at health centers. They condoned our study because it was a study and because they also recognize the reality that the policy cannot be implemented in many cases simply due to lack of resources and access in rural areas. After completion of the LUNESP study, Save the Children and Boston University’s Center for Global Health & Development assumed responsibility for sustaining the interventions through a program called LINCHPIN.

The Zambian MOH apparently is rethinking its policy on TBAs and I'm increasingly optimistic that they will move to incorporate this approach formally into their health care delivery strategy. I’m crossing my fingers.

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